Assessment Practice Q's
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A review of cardiac, neurological, and musculoskeletal assessment for Master's Level Assessment class.
- 1.An 80 year old woman presents to your clinic for evaluation of palpations and shortness of breath. You obtain an electrocardiogram, which reveals an irregularly irregular rhythm without discrete p waves. You diagnosis her with atrial fibrillation. The most likely physical finding upon auscultation of her heart is
- A.
An irregulary irregular rhythm
- B.
A rapid regular rhythm
- C.
A midsystolic click
- D.
Bigeminy
- 2.A 61 year old hairdresser presents for evaluation of shortness of breath. You examine her jugular venous pulse (JVP) and listen to her heart. You diagnosis her with right-sided heart failure. Your JVP measurement is most likely to be:
- A.
1 cm above the sternal angle
- B.
3 cm above the sternal angle
- C.
6 cm above the sternal angle
- D.
1 cm below the sternal angle
- 3.A 22 year old waitress presents to your clinic for evaluation of pain in her chest. She appears to be anxious. The pain is worse with physical exertion, such as climbing stairs. She does not smoke, use alcohol or illicit drugs, or consume excessive amounts of caffeine. You auscultate her heart and diagnosis mitral valve prolapsed. What did you hear to make this diagnosis
- A.
An opening snap
- B.
A midsystolic click
- C.
A diastolic rumble
- D.
A holo-systolic murmur
- 4.What could you ask a patient to do to accentuate the findings of a mitral valve prolapsed?
- A.
Perform a Valsalva maneuver
- B.
Squat
- C.
Hop on one foot
- D.
Kneel
- 5.
- A.
PMI in the fifth interspace, midclavicular line, 8 cm lateral to the midsternal line
- B.
PMI in the fifth interspace, anterior axillary line
- C.
PMI in the third interspace, midclavicular line
- D.
PMI in the eight interspace, anterior axillary line
- 6.Which of the following describes the S1 heart sound?
- A.
Occurs during atrial contraction
- B.
Produced by the closure of the mitral & Tricuspid valves
- C.
Occurs after the mitral valve opens; rapid ventricular filling
- D.
Produced by closure of the aortic & pulmonic valve
- 7.Which of the following describes the S2 heart sound?
- A.
Occurs during atrial contraction
- B.
Produced by the closure of the mitral & tricuspid valve
- C.
Occurs after the mitral valve opens; rapid ventricular filling
- D.
Produced by closure of the aortic & pulmonic valve
- 8.Which of the following describes the S3 heart sound?
- A.
Occurs during atrial contraction
- B.
Produced by the closure of the mitral & tricuspid valves
- C.
Occurs after the mitral valve opens; rapid ventricular filling
- D.
Produced by closure of the aortic & pulmonic valves
- 9.Which of the following describes the S4 heart sound?
- A.
Occurs during atrial contraction
- B.
Produced by the closure of the mitral & tricuspid valves
- C.
Occurs after the mitral valve opens; rapid ventricular filling
- D.
Produced by closure of the aortic & pulmonic valves
- 10.Which of the following descriptions best describes a GRADE 1 murmur?
- A.
Loud; may be associated with a thrill
- B.
Very faint
- C.
May be heard when the stethoscope is entirely off the chest
- 11.Which of the following descriptions best describes a GRADE 6 murmur?
- A.
Loud; may be associated with a thrill
- B.
Very faint
- C.
May be heard when the stethoscope is entirely off the chest
- 12.Which of the following descriptions best describes a GRADE 4 murmur?
- A.
Loud; may be associated with a thrill
- B.
Very faint
- C.
May be heard when the stethoscope is entirely off the chest
- 13.
- A.
Aortic stenosis
- B.
Mitral regurgitation
- C.
Mitral valve stenosis
- D.
Aortic Regurgitation
- 14.When auscultating a patients heart sounds you hear an Early diastolic decreased murmur. This would be indicative of what?
- A.
Aortic stenosis
- B.
Mitral regurgitation
- C.
Mitral valve stenosis
- D.
Aortic Regurgitation
- 15.When auscultating a patients heart sounds you hear a Pan-systolic plateau murmur. This would be indicative of what?
- A.
Aortic stenosis
- B.
Mitral regurgitation
- C.
Mitral valve stenosis
- D.
Aortic Regurgitation
- 16.When auscultating a patients heart sounds you hear a Midsystolic crescendo-decrescendo murmur. This would be indicative of what?
- A.
Aortic stenosis
- B.
Mitral regurgitation
- C.
Mitral valve stenosis
- D.
Aortic Regurgitation
- 17.
- A.
Orthostatic edema
- B.
Lymphedema
- C.
Lipedema
- D.
Chronic venous insufficiency
- 18.
- A.
Deep vein thrombosis
- B.
Arterial insufficiency
- C.
Venous insufficiency
- D.
Peripheral neuropathy
- 19.A 62-year-old accountant presents for evaluation of a rash on his lower legs. He has had this rash for several months. He denies fever or chills. The skin itches. He has tried OTC creams without success. He has smoked ½ pack of cigarettes daily for the past 20 years. On physical examination, the skin of his lower legs is hyperpigmented and bluish-red. He has a shallow ulcer on his right medial calf. His dorsalis pedis pulses are 2+ bilaterally, and he has normal hair distribution on his lower legs. These findings are most compatible with which one?
- A.
Deep vein thrombosis
- B.
Tinea pedis
- C.
Arterial insufficiency
- D.
Venous insufficiency
- 20.A 55-year-old- nursing assistant presents to your office because of persistent swelling in her feet. She is a nonsmoker. Her medical history is noncontributory. She has never had any surgeries. She works two 8-hour shifts daily, 6 days weekly. On physical examination, her BP is 110/60 mm/Hg; her cardiovascular examination is normal; and her legs have 2+ pitting edema bilaterally without rashes, thickening, or ulceration of the skin. What is your most likely diagnosis?
- A.
Orthostatic edema
- B.
Lymphedema
- C.
Lipedema
- D.
Chronic venous insufficiency
- 21.What kind of edema would you see with Right sided heart failure?
- A.
Dependent edema; sacral edema when patient is supine; may see increased JVD, enlarged liver, enlarged heart;
- B.
Edema in the loose subcutaneous tissues of the eyelids; may also appear in the feet and legs
- C.
Localized edema; involves one or both legs
- D.
Edema of the dependent areas; no cardiac or hepatic signs
- 22.A 29-year-old sales representative for a pharmaceutical company presents to your office for evaluation of pain in her jaw. The pain has been present daily for the past 2 weeks. She denies any history of trauma or injury. Her medical history is unremarkable. She is able to eat without difficulty but hears a clicking sound from her jaw. She denies fever or chills. On physical examination, you palpate the temporomandibular joint and ask the patient to open her mouth. You feel crepitus when she opens and closes the jaw. Based on this information, what is your most likely diagnosis?
- A.
Mandible fracture
- B.
Pterygoid weakness
- C.
Osteomyelitis
- D.
Temporomandibular joint dysfunction
- 23.A 50-year-old physician presents for evaluation of pain in his right shoulder. The pain has been intermittent for the past 20 years, but over the past 3 weeks, it has been present daily. He has tried OTC analgesics, but they do not relieve the symptoms. 5 years ago, he fell on the icy pavement and landed on his shoulder. You perform a physical examination maneuver, because you suspect a rotator cuff tear. What is the name of this test?
- A.
Drop arm test
- B.
McMurray’s test
- C.
Anterior drawer test
- D.
Tinel’s test
- 24.A 35-year-old factory worker presents to your office for evaluation of pain in his left arm. He denies any acute trauma or injury. His job involves inspecting jars, and he has to test the opening and closing of the jar lids. He denies fever or chills. On physical examination, there is no swelling over the elbow. You palpate the olecranon process, and he has tenderness on the left lateral epicondyle but not on the medial epicondyle. Based on this information, what is your most likely diagnosis?
- A.
Olecranon bursitis
- B.
Osteoarthritis
- C.
Lateral epicondylitis
- D.
Epicondylar fracture
- 25.A 27-year-old software specialist presents to your office for evaluation of numbness and pain in his fingers. He has noticed that the numbness increases as the day goes on; at first he noticed it only at the end of the day, but now it is present upon awakening. It is present in both his hands. The pain started several months ago and is not relieved by OTC analgesics. The patient’s family history is significant for HTN and cerebrovascular disease. On physical examination, his BP is 110/70 mmHg and his thenar eminence is atrophic. Which tests would you perform to confirm your initial hypothesis of carpal tunnel syndrome
- A.
Tinel’s test
- B.
Anterior drawer test
- C.
McMurray’s test
- D.
Allen test
- 26.A 35-year-old postal worker presents to your office for evaluation of pain in her joints. She states that the pain is worse in her fingers and wrists; both hands are affected. She notices that it takes her longer than 1 hour to get moving in the morning because she is so stiff. For the past few weeks, she has been having fevers, some as high as 100.5℉. You notice that she has fusiform swelling in her fingers and wrists bilaterally and that the PIP and MCP joints are tender to palpation. Based on the history and physical examination findings, what is your most likely diagnosis?
- A.
Osteoarthritis
- B.
Rheumatoid arthritis
- C.
Gouty arthritis
- D.
Ankylosing spondylitis
- 27.A 55-year-old executive assistant presents to your office for evaluation of pain in her wrist. She states that the pain has been present daily. She has taken OTC analgesics for the pain, which seem to help. She denies fever, chills, or rashes. On physical examination, she has pain and tenderness over the right wrist but not the left. She has a hard dorsolateral nodule on the DIP joint of her right middle finger. The MCP joints are normal. What is your most likely diagnosis?
- A.
Gouty arthritis
- B.
Rheumatoid arthritis
- C.
Systemic lupus erythematosus
- D.
Osteoarthritis
- 28.A 13-year-old junior high school student is brought into your office by her mother for evaluation of unequal shoulder height. Her mother first noticed this problem 2 weeks ago. There is no history of birth trauma or recent injury. On physical examination, there is a lateral curvature to the spine. The curvature is more pronounced with forward flexion. Based on this information, what is your most likely diagnosis?
- A.
Normal spinal curvature
- B.
Kyphosis
- C.
Scoliosis
- D.
Lumbar lordosis
- 29.A 90-year-old retired business owner presents to your clinic for evaluation of excruciating back pain. She denies fever or chills. She states that the pain started suddenly but denies trauma or injury to the back. On physical examination, the patient has thoracic kyphosis, which you have noted in the past. You palpate the spine and note exquisite tenderness at L3 and L4. There are no step-offs. The patient has limited ROM secondary to pain. Deep tendon reflexes are 2+ bilaterally in the lower extremities. The straight leg raise is negative. Based on this information, what is your most likely diagnosis?
- A.
Compression fracture
- B.
Meningitis
- C.
Herniated disc
- D.
Spondylolisthesis
- 30.An 18-year-old college football player comes to your office after sustaining an injury on the field. He states that he planted his foot and had to pivot to catch the ball. He heard a “pop,” and his right knee gave way and started to swell. The trainer iced it down. On physical examination, you note increased swelling and tenderness over the right knee. He has significant forward excursion when you perform the Lachman test. He also has more movement of the right tibia when you draw it forward when compared with the left. Based on this information, what is your most likely diagnosis?
- A.
Posterior cruciate ligament tear
- B.
Anterior cruciate ligament tear
- C.
Meniscus tear
- D.
Patellar tear
- 31.A 23-year-old fast food worker presents to your office for evaluation of pain in his feet, especially the heels. He notes that the pain is most intense when he first awakens, then eases up somewhat after walking for a few minutes. By the end of the day, the pain has returned again to its full intensity. He has tried OTC analgesics without success. He denies fever, chills, trauma, or injury to his feet. On physical examination, he has tenderness upon palpation of the plantar fascia. There are no deformities or joint swelling. What is your most likely diagnosis?
- A.
Ankle sprain
- B.
Heel spur
- C.
Plantar fasciitis
- D.
Gout
- 32.An 18-year-old college freshman presents to the emergency room for evaluation of fever, headache, and neck stiffness. On physical examination, the patient is resting quietly and has a flushed face. His vital signs are as follows: temperature, 104 degrees F; pulse, 110 bpm; and BP, 105/70 mmHg. He has no rashes. During the physical examination, you flex the patient’s neck and hips and knees flex in response, indicating meningeal irritation. The name of this positive sign is:
- A.
Kernig’s sign
- B.
Brudzinski’s sign
- C.
Babinski’s sign
- D.
Lachman’s sign
- 33.A 22-year-old daycare worker comes to the clinic for evaluation of fever as high as 103.5 degrees F, headache, and neck pain. She has photophobia and neck stiffness. During the physical examination, you flex the patient’s leg at both the hip and the knee and then straighten her knee to elicit meningeal irritation. The patient experiences severe pain. The name of this sign is:
- A.
Kernig’s sign
- B.
Brudzinski’s sign
- C.
Babinski’s sign
- D.
Lachman’s sign
- 34.
- A.
Pupils equal and reactive to light, pinpoint
- B.
Pupils fixed and dilated
- C.
Pupils unequal to light
- D.
One pupil fixed and dilated
- 35.A patient is brought to the emergency room for evaluation of mental status changes. She has a history of a fever as high 105 degrees F. She has had a headache and symptoms consistent with an upper respiratory infection 2 weeks before the worsening of these symptoms tonight. You are updating this patient’s clinical progress. You diagnose her with a coma. You note that her respiratory pattern has become irregular, with Cheyne-Stokes breathing. Her pupils, which were previously equal, are now unequally reactive to light. What is the most likely cause of her coma?
- A.
Drug overdose
- B.
Alcohol intoxication
- C.
Uremia
- D.
Brain abscess
- 36.A 25-year-old housewife presents to the urgent care clinic for evaluation of paralysis in her face. She has a history of an upper respiratory 2 weeks before the onset of these symptoms. She states that her face is drooping and that she is unable to close her eye. On physical examination, you note that her forehead is smooth on the right side, her palpebral fissure appears widened, and her nasolabial fold appears flattened and she is drooling. Based on this information, what is the most likely diagnosis?
- A.
Cortical stroke
- B.
Bell’s palsy
- C.
Horner’s syndrome
- D.
Stress reaction
- 37.A 35-year-old reporter presents to you office for evaluation of back pain and weakness in his left leg. He was play-wrestling with his nephew and hurt his back 2 weeks ago. He states that he has noticed tingling in his left leg as well. He has not noticed incontinence of bowel or bladder function. You perform a physical examination and confirm that he is dragging his left foot when he walks and that his Achilles reflex is diminished. You diagnose him with a herniated disc. Which nerve root are you testing with the Achilles reflex?
- A.
C5, C6
- B.
L2, L3, L4
- C.
S1
- D.
L4, L5
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